This section is from the book "Smith's Family Physician", by William Henry Smith. See also: Natural Physician's Healing Therapies: Proven Remedies that Medical Doctors Don't Know.
Jaundice is an occasional symptom of both acute and chronic inflammation of the liver; but Jaundice is often spoken of as constituting a distinct form of disease. The symptoms of the disease are, yellowness of the eyes and of the skin, whitish or drab-coloured stools; urine having the colour of saffron, and giving a bright yellow tinge to white linen. But sometimes the motions are of a healthy colour, when the Jaundice is unmistakeable. The bowels are generally costive, but not always; in some of the worst cases, in which the Jaundice depends upon disease of the liver, which is connected also with disease of the mucous coat of the intestines, there is constant diarrhoea.
In some cases, the yellowness of the skin is preceded, or accompanied at first by itching, which is occasionally so intolerable as to require the employment of Opiates to allay it. In most cases there is no itching at all. Bilious sweats sometimes occur, staining the patient's linen yellow. The saliva, in some jaundiced patients, has the same yellow tinge, and a distinctly bitter taste. And in some persons everything they look at appears yellow.
The shades of yellowness are different in different persons. The young, and those who are pale and fair, present a bright lemon colour. In those who are florid, or whose cheeks and skin are flushed with fever, the tint will more resemble that of a Seville Orange. Again, if the patient be naturally swarthy, or if his visage be dusky through imperfect arterialization of his blood, the addition of Jaundice will give him a greenish or olive hue.
Jaundice depends upon various and different internal causes, and we frequently cannot determine at all, until death gives us the opportunity of inspecting the parts, what the precise exciting cause may be. In some cases a gall-stone blocks up the passages. The pain that attends the passage of a gall-stone is sometimes very severe; this is not surprising when it is considered that a stone the size of a walnut sometimes forces its way through a tube, the natural size of which is not much larger than a goose-quill. The voiding of biliary stones by stool may happen over and over again without its being noticed, and it does not help us at all to judge of the nature of the complaint at its commencement, while the gall-stone is still within the ducts. With the pain, which is not constant, but comes and goes, there is commonly much nausea and vomiting; and sometimes hiccup; and the matters vomited are usually very sour. The patient is flatulent and dyspeptic; languid and gloomy. At length the concretion passes into the intestines; the pain suddenly ceases, and all is soon well again. Attacks of this kind, having happened once, are very apt to be repeated. And when Jaundice, associated with the peculiar pain, has once occurred, repetitions of the pain may fairly be attributed to gall-stones, although there may be no repetition of the Jaundice, and many repetitions of Jaundice justify the suspicion of gall-stones. This pain might be mistaken for inflammation, were it not that there is no tenderness and no fever. Pressure instead of increasing usually mitigates the pain. At least, this is the case at the beginning of the attack before there has been much retching; for a certain amount of tenderness of the abdominal muscles is often produced by repeated straining and vomiting. The pulse is not usually quickened daring the pain.; occasionally it is even slower than natural, and the skin cold; shiverings sometimes occur.
Occasionally, inflammation arises, and then the pulse becomes frequent, and the skin hot, and thirst and headache are complained of, and the stomach feels tender on pressure. Sometimes the gall-stone makes its way, by ulceration, through the adjoining structures, and so is discharged outwardly, or into the bowels. When once a large stone has forced its way through the natural channels of the bile, they remain permanently dilated; and smaller stones may be afterwards voided without pain or other notice of their passage. There are people who get rid of scores of them in this way, during the course of their lives.
Sometimes a large concretion, after its extrication from the biliary passages, lodges in the more capacious intestines, and gives rise to serious obstruction there; but, in general, the concretions are avoided with the stools; and they should be looked for there.
When concretions pass which are small and angular, having several flat surfaces, we are to expect that more will follow them. If a single stone come, large, smooth and roundish, we may hope that it has left none behind it.
Jaundice has been known to terminate upon the passage through the bowels of concrete bile, in the shape of a black, gritty powder, very like powdered cinders or coal dust.
We often find gall-stones, even in vast numbers, in the gallbladders of persons who, during their lifetime had never been known to suffer pain about the liver, or to have Jaundice, or to exhibit any token of the presence of such concretions. Dr. Watson says: "I have-heard of an instance in which upwards of 1300 gall-stones were taken from a human gall-bladder after death.
Fits of anger, of fear, of alarm, have been presently followed by Jaundice; and it has also been produced by great bodily suffering, by a severe surgical operation, or perhaps by the dread which attended it. Mr. North witnessed a case, in which an unmarried woman, on its being accidentally disclosed that she had borne children, became in a very short time yellow. There are scores of instances on record to the same effect: and this is observable of such cases, that they are often fatal, with head symptoms; convulsions, delirium, or insensibility, following upon the Jaundice.
Jaundice was reported as epidemic in a portion of the army of the United States, during the late war in the South. 10,929 cases of it occurred, with 40 deaths.
Jaundice occasionally comes on during pregnancy; and disappears after childbirth. The little exercise that pregnant women usually take, and the costiveness that frequently attends their condition, are probably the causes.
In that species of Jaundice which occurs in connection with acute or chronic inflammation of the liver, the treatment must be the same as is there recommended. Should fever attend the passage of a gall-stone, or should the pain in the body become tenderness, leeches may be applied over the spot which is painful. But, in general, bleeding is not requisite nor of service in this variety of Jaundice. Our great resource for relieving the pain, and for loosening the presumed spasm, is Opium, given in full doses: it is best taken in the form of a pill, one grain for a dose. As a grain of solid Opium makes but a small pill, the stomach will generally retain it, when a dose of Laudanum would probably be rejected by vomiting. Sometimes the stomach is so irritable as to reject even a pill, and in that case about 30 or 40 drops of Laudanum may be given in an injection of half a pint of warm gruel. Warm baths are valuable adjuncts, but if these cannot be obtained, hot fomentations or mustard poultices may be used instead. Dr. Prout states that he has seen more benefit afforded by large draughts of hot water containing the Carbonate of Soda in solution, (one or two drams to a pint), than by any other means. He says: "The alkali counteracts the distressing symptoms produced by the acidity of the stomach; while the hot water acts like a fomentation to the seat of pain. The first portions of the water are commonly rejected almost immediately; but others may be repeatedly taken; and after some time it will usually be found that the pain becomes less, and the water is retained. Another advantage of this plan of treatment is that the water abates the severity of the retching, which is usually most severe and dangerous when there is nothing present upon which the stomach can react. This plan does not supersede the use of Opium, which may be given in any way deemed most desirable; and in some instances a few drops of Laudanum may be advantageously joined with the alkaline solution, after it has been once or twice rejected." The pain having subsided, the bowels should be cleaned out with a brisk purgative.. The diet must be light and nourishing.